Konstantinos Perreas1, George Samanidis2, Apostolis Thanopoulos3, Georgios Georgiopoulos4, Theofani Antoniou3, Mazen Khoury5, Alkiviadis Michalis5, Andreas Bairaktaris1. 1. First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. 2. First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: gsamanidis@yahoo.gr. 3. Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece. 4. Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 5. Second Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
Abstract
BACKGROUND: Over the years, numerous options have been proposed for surgical management of ascending aorta and aortic arch pathology in an attempt to minimize postoperative morbidity and probability of death. We present a propensity score-matching analysis of 259 patients from a single unit who were operated on under deep hypothermic arrest with retrograde cerebral perfusion (DHCA/RCP) or moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion (via common carotid artery) (MHCA/ACP). METHODS: Between 2006 and 2014 a total of 259 consecutive patients underwent ascending aorta and hemiarch correction under HCA. DHCA/RCP and MHCA/ACP were performed on 207 and 52 patients, respectively. Baseline patient characteristics accounted for in the propensity matching were age, sex, acute aortic dissection, emergency operation, re-operation, preoperative hemodynamic instability, preoperative kidney injury, and CA time. After propensity scoring 40 pairs (80 patients) were successfully matched (p = 0.732). Outcomes were defined as the incidence of postoperative neurologic complications, 30-day mortality, and all-cause midterm mortality. RESULTS: Surgical procedure that involved the MHCA/ACP technique was associated with 76.5% decreased risk (risk ratio, 0.235; 95% CI, 0.079 to 0.699) of postoperative neurologic complications (p = 0.009). In addition to MHCA/ACP in surgical procedure for acute aortic dissection a relevant trend was established for 30-day mortality (risk ratio, 0.333; 95% CI, 0.09 to 1.23). For midterm all-cause mortality, MHCA/ACP modestly decreased the number of deaths (p = 0.0456) in comparison with the DHCA/RCP technique. CONCLUSIONS: MHCA/ACP in aortic arch surgical procedure is associated with a decreased risk of all types of neurologic complications and a trend toward decreased 30-day and midterm mortality in comparison with DHCA/RCP.
BACKGROUND: Over the years, numerous options have been proposed for surgical management of ascending aorta and aortic arch pathology in an attempt to minimize postoperative morbidity and probability of death. We present a propensity score-matching analysis of 259 patients from a single unit who were operated on under deep hypothermic arrest with retrograde cerebral perfusion (DHCA/RCP) or moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion (via common carotid artery) (MHCA/ACP). METHODS: Between 2006 and 2014 a total of 259 consecutive patients underwent ascending aorta and hemiarch correction under HCA. DHCA/RCP and MHCA/ACP were performed on 207 and 52 patients, respectively. Baseline patient characteristics accounted for in the propensity matching were age, sex, acute aortic dissection, emergency operation, re-operation, preoperative hemodynamic instability, preoperative kidney injury, and CA time. After propensity scoring 40 pairs (80 patients) were successfully matched (p = 0.732). Outcomes were defined as the incidence of postoperative neurologic complications, 30-day mortality, and all-cause midterm mortality. RESULTS: Surgical procedure that involved the MHCA/ACP technique was associated with 76.5% decreased risk (risk ratio, 0.235; 95% CI, 0.079 to 0.699) of postoperative neurologic complications (p = 0.009). In addition to MHCA/ACP in surgical procedure for acute aortic dissection a relevant trend was established for 30-day mortality (risk ratio, 0.333; 95% CI, 0.09 to 1.23). For midterm all-cause mortality, MHCA/ACP modestly decreased the number of deaths (p = 0.0456) in comparison with the DHCA/RCP technique. CONCLUSIONS: MHCA/ACP in aortic arch surgical procedure is associated with a decreased risk of all types of neurologic complications and a trend toward decreased 30-day and midterm mortality in comparison with DHCA/RCP.
Authors: Robert B Hawkins; J Hunter Mehaffey; Emily A Downs; Lily E Johnston; Leora T Yarboro; Clifford E Fonner; Alan M Speir; Jeffrey B Rich; Mohammed A Quader; Gorav Ailawadi; Ravi K Ghanta Journal: Ann Thorac Surg Date: 2017-06-06 Impact factor: 4.330
Authors: Oksana Vasilyevna Kamenskaya; Asya Stanislavovna Klinkova; Alexander Mikhailovich Chernyavsky; Vladimir Vladimirovich Lomivorotov; Ivan Olegovich Meshkov; Alexander Mikhailovich Karaskov Journal: J Extra Corpor Technol Date: 2017-03
Authors: Vinay Garg; Mark D Peterson; Michael Wa Chu; Maral Ouzounian; Roderick Gg MacArthur; John Bozinovski; Ismail El-Hamamsy; F Victor Chu; Ankit Garg; Judith Hall; Kevin E Thorpe; Natasha Dhingra; Hwee Teoh; Thomas R Marotta; David A Latter; Adrian Quan; Muhammad Mamdani; Peter Juni; C David Mazer; Subodh Verma Journal: BMJ Open Date: 2017-06-10 Impact factor: 2.692